The Efficacy of Pelvic Floor Therapy in Enhancing Muscular Function and Providing Colorectal Symptom Relief: A Case Report.

INTRODUCTION

The pelvic bowl is lined by a network of muscles that provide structural organ support and assist with bodily functions. Like other muscles of the human body, pelvic floor muscles may hold tension or exhibit diminished or excessive tone due to various causative factors. This deviation is comprehensively referred to as Pelvic Floor Dysfunction (PFD). Approximately one in five individuals in the United States will experience some manifestation of symptomatic Pelvic Floor Dysfunction. Furthermore, an estimated 10% of female-bodied patients in the United States will undergo surgery for PFD symptoms such as incontinence, pelvic organ prolapse, or both, with 30% of this subgroup undergoing multiple surgeries. These statistics underscore the substantial burden of PFD imposed on individuals within the United States and highlight the importance of exploring less invasive treatments, such as Pelvic Floor Therapy (PFT), which aim to address muscular dysfunction without the risks associated with surgical intervention.

METHODS

In July 2023, a 47-year-old female presented to the NUNM Clinic for a pelvic floor consultation for a 1.5-year history of episodic fecal incontinence, fecal urgency, and diarrhea with previous work-up yielding unremarkable results. Pelvic floor muscular assessment was conducted via digital intravaginal palpation and graded utilizing the Modified Oxford Scale. During this physical examination,markedly hypotonic pelvic floor muscles were identified as well as several areas that were tender to palpation. Subsequent pelvic floor therapy (PFT) sessions and at-home Kegel and core exercises were initiated. The PFT sessions were held weekly for 3 visits, and biweekly for the following 2 months.

RESULTS

By the end of the first month of treatment, the patient exhibited noteworthy improvements in muscle tone andstrength as graded by a Modified Oxford Scale. She also demonstrated enhanced voluntary control of initating, holding, and releasing contractions. The patient reported no episodesof fecal incontinence after the third PFT session. These improvements remained consistent throughout the 2 month follow-up period during which PFT continued on a biweekly basisAt a follow up visit 3 months later, the patient reported no episodes of fecal incontinence since last PFT session.

DISCUSSION/CONCLUSION: This case highlights the pivotal role of PFT in improving hypotonic pelvic floor musculature and associated symptoms. The patient's marked improvements suggest that conservative management with targeted PFT and guided exercises can offer a valuable alternative or adjunct to surgical intervention for PFD, not only for fecal incontinence but also for other symptoms that result from a hypotonic pelvic floor including, but not limited to, urinary incontinence, pelvic organ prolapse, and pelvic pain. This case study has limitations including the absence of a control group and limited long-term follow-up data, which restricts the ability of the findings to be generalized. Future research should involve larger patient cohorts, RCTs, and extended monitoring in order to further validate the efficacy of PFT for managing symptoms caused by imbalanced pelvic floor musculature. Additionally, investigation into standard assessment protocols and optimal treatment timing is essential in order to establish best practice guidelines.